Managing Your Medical Office StaffAn HR Guide for Physicians

“Managing Your Medical Office Staff: An HR Guide for Physicians” is part of a series of guides the OMA has made available to help physicians address a range of practice management topics. The guides walk you through issues and opportunities at various stages of practice, from opening up, managing, to winding down a medical practice.

Other titles in the series, which you can find at www.oma.org, include:

• First Impressions: Medical Facility Planning Guide

• First Impressions: The Patient Experience Guide

• Revenue Management: Prescriptions for a Profitable Medical Practice

• Starting a Practice: A Guide for New Physicians

• Closing a Practice: A Guide for Physicians

• Closing a Practice: When the Unexpected Happens

About This Series

This guide contains the following sections and appendices:

A. Introduction 5

B. Recruitment and Hiring 6

Accessing staffing needs? 6

Defining your staff 6

The hiring process 6

Creating a job description 6

Establishing employment conditions 7

Recruiting and screening candidates 7

Interviewing 7

Rating candidates 7

Testing 8

Checking references 8

Hiring 8

Developing a policy and procedure manual 8

C. Motivation and Retention 9

Keep communication open 9

Provide ongoing feedback 9

Set clear goals 9

Create a satisfying environment 9

Provide meaningful rewards 9

D. Performance Appraisals 10

What is a performance appraisal? 10

Why are performance appraisals essential? 10

What is the appraisal based on? 10

Which staff should be assessed? 10

How often should appraisals be held? 10

How should employees be rated? 10

Table of Contents

E. Termination 11

What justification is needed to terminate an employee? 11

What kind of notice is required for termination? 11

When are employees not entitled to a notice of termination or termination pay under the ESA? 11

What are the employer’s requirements during the statutory notice period? 11

F. Conclusion 12

APPENDICES

Appendix A: Assessing staffing needs 12

Appendix B: Recruiting/Hiring process checklist 14

Appendix C: Human resources legislation links 16

Appendix D: Job description template 17

Appendix E: Interview questions template 19

Appendix F: Interview rating scale form template 20

Appendix G: Code of conduct template 21

Appendix H: Policy and procedure manual template 25

Appendix I: Performance appraisal template 26

Table of Contents

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As a medical practice leader, you draw on many strengths to achieve your goals, including your abilities, your knowledge, your dedication, and your team.

Running an effective office starts with staffing. Having the appropriate personnel in place will support the ideal patient-centred care, help you turn your vision and values into action, and maximize your ability to focus on the practice of medicine.

Human Resources (HR) is a challenge for any organization. This is especially true for physicians, who are busy with direct patient care. The Ontario Medical Association (OMA) has prepared this guide to provide advice on how to determine your staffing needs, recruit your team, create a code of conduct, motivate your employees, conduct performance appraisals, and more. You will also find useful tools such as a job description template, sample interview questions, interview rating form, and links to key HR legislation.

In any medical practice, the right staff and appropriate staff management can keep your office running smoothly, make a positive impression on patients, and yield more rewards than any other investment a physician can make in their practice. Use this guide to help make smart HR decisions.

For questions or more information about managing HR, please call the OMA’s Practice Management and Education Services toll-free at 1.800.268.7215 (416.599.2580 in the Toronto area), or email practicemanagement@oma.org.

A. Introduction

Disclaimer: The information contained in this document is intended to be used as a reference guide only. While every effort has been made to provide accurate and current information, the OMA does not make any representations, warranties or conditions (either express or implied) with respect to the accuracy or reliability of the information provided.

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B. Recruitment and Hiring

Assessing staffing needs

Staffing is the process of selecting and training individuals, and charging them with specific responsibilities. In a medical office, a combination of four factors typically shape staffing.

1. What is the medical specialty? The services that you offer may require a specific number or types of employees for adequate support.

2. How many providers do you have? Whether you have two physicians or 25, medical providers need adequate staffing to support them in delivering quality services. Research other medical offices to get a sense of the typical number of employees per physician, and help ensure that you are not understaffed or overstaffed.

3. What is the patient volume? The number of patients treated daily, weekly, monthly, and annually creates the workload, and can dictate the staffing level required.

4. What kind of productivity do you want to achieve? The ratio of staffing to services rendered, as well as the roles you have assigned, will affect your efficiency.

These factors do not always remain permanent in a medical office. As they change, so can your staffing needs, so stay flexible. Staffing will also be shaped by the type of organizational structure you prefer (e.g., centralized or decentralized), and how much responsibility you want to delegate. There is no single correct approach. In assessing your staffing requirements, the goal is to have a team in place that can meet your expectations for serving patients.

Defining your staff

You can think of staffing in terms of three levels: leadership, management and direct service providers. A solo practitioner in a small medical office may need to fill all roles, while larger offices will have more delineation

between the levels. In general, staffing in a medical office can encompass these roles:

• Licensed clinicians: such as a Nurse Practitioner, and other health-care professionals.

• Office manager: responsible for the administrative/business side of medicine, while the health-care professionals take care of the clinical side.

• Medical secretary: responsible for patient scheduling, medical report transcription, medical records management, and medical billing.

• Billing specialist: responsible for managing the information related to OHIP, WSIB and uninsured billings.

• Receptionist: responsible for answering the telephone, welcoming patients, and booking patient appointments.

Keep in mind that in some settings, staff will perform multiple roles. In fact, cross-training can be advantageous to allow proper coverage in case of sick days, holidays, etc. On the other hand, specialization allows for undivided attention. The precise definition of roles is up to each office. See Appendix A for more guidance on assessing your staffing needs.

The hiring process

Having determined your staffing needs, you must prepare to select the right candidate. Your odds for success can increase dramatically by following a systematic procedure, from creating a job description through to hiring an individual. A Recruiting/Hiring Process checklist is available to assist you with the task (see Appendix B). Follow the steps below, and remember, as an employer you need to become familiar and comply with several pieces of Human Resources legislation (see Appendix C).

Creating a job description

A job description is a formal document that summarizes the important functions of a specific job on which job postings, job interviews, and performance appraisals

HR management is about managing your employees and ensuring they meet the strategic and operational goals of the medical practice. Physicians rely heavily on office staff for day-to-day operations; therefore, it is prudent to hire the right people, develop and train staff that will meet the practice’s goals, and retain the right people.

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are based. Job descriptions should accurately represent actual duties and responsibilities, as well as job specifications.

For each position, list all duties and responsibilities, ranking them based on the importance of the function and the percentage of the time needed to perform the duty. Clearly state all formal requirements, such as experience, education or special training (see Appendix D for a job description template).

These qualifications, along with the level of responsibility, will determine the salary that fits the job description. Colleagues, hospital personnel administrators and employment agencies can give you guidelines for pay scales and benefits in your area.

Attempt to establish standards for each job function, which can later be used to conduct performance appraisals.

Establishing employment conditions

Job candidates are entitled to know about the position being offered, general working conditions, and your expectations for performance. Before you start recruiting and interviewing, establish the conditions under which employees will be hired.

Be realistic in creating these guidelines. If the conditions do not match expectations, and the job is not as described, you may lose candidates or staff and be forced to repeat the hiring process.

Recruiting and screening candidates

To solicit candidates, consider several options:

• advertise through local medical societies, websites, newspapers, and community hospitals

• contact the placement office at a community college, or

• use an employment agency, which usually charges a fee based on the percentage of the newly hired employee’s salary (if you hire through an agency, be sure to obtain a time-related guarantee of satisfaction).

The method you choose might depend on the time you have available to handle responses and make the hire.

Recruit as many candidates as possible. The more applicants, the better your chances are of selecting the right one. Ask for written resumes, and learn the art of reading them — ambiguous statements, frequent job

changes and missing employment dates, for instance, can be warning signs.

Not everyone will match all of your requirements. You may not find the perfect candidate. But when you identify candidates with the appropriate work experience, training and personal characteristics, place them on your list for a telephone interview.

Interviewing

Having selected the most promising resumes, arrange the interviews. This will permit you to:

• ask questions about the candidate’s job experiences;

• gain some understanding of their personality traits;

• form a first impression about their suitability;

• explain duties and responsibilities in detail; and,

• provide information on fringe benefits, hours of work, etc.

The types of questions you ask during the interview are important (see Appendix E for some sample interview questions). Ask each candidate the same series of questions so that you develop a common basis for comparison. Focus on each candidate’s competence, character, and drive, and take notes about their strengths and weaknesses so that you can refer back when considering your final selection.

Confine your questions to job-related subjects. Government regulations and human rights legislation forbid you to ask questions related to age, sex, marital status, religion, race and a host of other topics. It is advisable to contact the Ontario Human Rights Commission - www.ohrc.on.ca for guidelines on suitable questioning techniques.

Before the candidates leave the interview, obtain permission to contact their references.

Rating candidates

Another way of rating candidates equitably is to use an interview rating form (see Appendix F for a sample interview rating form). This lets you quantify the skills and personality traits you consider most useful for the job. Evaluate the various categories with the job description in mind, only then can you assign meaningful weighting values. Fill out this form immediately after the candidate leaves the interview, which helps keep the rating system objective.

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If you are not comfortable judging the skills required of a potential employee, just rate the candidate on other characteristics, and seek assistance regarding technical competence. For example, you could have your accountant interview and give an opinion on a potential bookkeeper.

Testing

After conducting the interview, you still need to assess and rank your candidates in order to make the best selection. Tests are one way to ascertain technical competence. Keep the tests with the candidate’s application and interview summaries — they will help you make your final decision.

Checking references

Do your homework by talking to references of the most suitable candidates. It is especially important to speak with the candidate’s immediate supervisor. The personnel manager may be reluctant to talk about former employees — often because they do not know them well — and may not provide more than “yes” or “no” answers.

Ask questions such as:

• In what area did the person work?

• What kinds of interpersonal skills does the person have?

• How was the quality of their work?

• What was their workload and performance like?

• What was the person’s attendance like?

• What were their best/worst attributes?

• What salary were they being paid?

• Why did they leave?

You may not get answers to all the questions, but you should be able to compare responses to the impression you formed from your own interview.

Hiring

Once you determine that a job applicant meets the position’s requirements, it is time to make a job offer (with the assistance of a lawyer, as needed). The job offer should include a probationary period with termination for any reason during that time. Background checks such as criminal and credit, education and license verification, and references can be done during this period.

The OMA recommends that physicians sign written contracts with all employees, and has a variety of templates available for this purpose. Contracts must be signed upon employee acceptance of the offer, prior to the first date of employment.

Please contact OMA Legal Services at legal.affairs@oma.org or your own lawyer for further information on employment contracts and the hiring process.

Developing a policy and procedure manual

As you develop positions on a variety of practice and workplace issues, document them in a policy and procedure manual. These are the rules by which you operate. They will help you to train staff, ensure that the office runs efficiently and in a consistent manner, and maintain productive and clear working relationships.

Policies and procedures can cover a wide range of topics, such as the length of a probationary period, work hours, absenteeism, code of conduct (see Appendix G), dress code, how to complete specific tasks, e.g. sending claims to OHIP, recording information in patient files, and much more (see Appendix H for a policy and procedure manual template).

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C. Motivation and Retention

Keep communication open

• Communicate your practice objectives and your staff’s role in achieving them. With a clear understanding of how they contribute to the success of the practice, staff feel a greater sense of accomplishment.

• Discuss important decisions in advance, and hold regular staff meetings. Keep everyone informed about developments in the office.

• Encourage staff to express their views on processes, job satisfaction, morale, etc. It is important for employees to feel that their opinions are welcome. Moreover, staff feedback can help you to improve your practice.

• Foster open communication, not just between you and your staff but among staff. That helps to create a more coordinated and better performing team — a feeling of “we” and not “me.” Communication is a two-way process.

Provide ongoing feedback

For employees to succeed, they need to know what they are already doing well and what they could do better. Provide prompt praise for good performance, constructive criticism on areas that need improvement (always privately), and updates on progress. This can happen through formal annual reviews (see Section D - Performance Appraisals) and, just as important, through informal day-to-day feedback.

Set clear goals

Organizations and individuals succeed when they are working with a plan. Staff feel valued, motivated to improve, and part of the team when they have a clear idea of expectations. For each employee, set goals that are:

• relevant: they mesh with your overall objectives

• realistic: staff can directly influence them through their actions and behaviours

• measurable: you have a way to determine if they have been achieved.

Create a satisfying environment

Staff are more likely to perform at their best (and to stay) when they are working within an environment that supports and stimulates them. That means providing employees with:

• a comfortable, safe, inclusive and respectful work setting

• a well-defined role

• the tools, time and resources they need to do their job

• the help and training to enable them to do their job well and develop new skills

• interesting challenges, and

• appropriate rewards (see below).

Provide meaningful rewards

Salary is important, but it is not everything. Although remuneration and the promise of a bump in pay can be a motivator, rewards take many other forms, and complement a good salary. Also remember that not all employees are motivated by the same thing.

Consider the full range of what compensates and motivates staff – flexible working conditions, team-building events, the chance for advancement, varied work, bonuses, incentives, benefits, training and development, special projects, etc. Taking it all into account will help you to create a reward structure that all employees value. Each employee should see a link between their efforts and their rewards.

Managing staff is really about motivating them. Every employee has different needs, goals and priorities. By understanding and meeting them, you can increase your staff’s effectiveness and job satisfaction, inspiring them to work to their potential.

Motivation and retention go hand in hand. Motivated employees are less likely to leave, saving you from losses like the costs of recruitment and training, and the disruption caused for the team. Here are some strategies to think about motivation and retention efforts.

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D. Performance appraisals

What is a performance appraisal?

A performance appraisal is a formal review of how an employee fares against objective criteria, and is a tool designed to facilitate constructive discussion between the employee and his/her supervisor. This exchange can clarify performance objectives, provide feedback about the employee’s performance with respect to skills and behaviours, provide a framework for identifying the employee’s development plans, and to serve as a basis for merit increase decisions. The goal is to create a documented assessment of an individual’s performance, and a plan for future development (see Appendix I for a performance appraisal template which can be adjusted for the practice).

Why are performance appraisals essential?

Formal appraisals are vital for managing the performance of people and organizations. They contribute to effective management by helping you to:

• identify areas of strength and weakness among your staff;

• develop individual training;

• monitor standards, expectations and objectives;

• communicate the aims of the practice, and align individual and practice goals;

• foster positive relationships with staff;

• determine annual pay; and,

• improve overall organizational performance.

What is the appraisal based on?

Appraisals compare the individual’s performance to their job description, and to goals and standards agreed upon at a previous appraisal.

A job description may change over time to meet the needs of the office. Always make any change with the

agreement of the employee (and perhaps seek legal advice too). If the job description changed, base the review on the current one. Note that employers cannot unilaterally change the job description; this is akin to constructive dismissal.

Which staff should be assessed?

Formal performance appraisals are generally conducted annually for all staff in the organization. Each staff member is appraised by their direct manager.

How often should appraisals be held?

Once or twice a year is advisable. Aside from these regular appraisals, managers should have one-on-one discussions throughout the year with staff regarding work progress, training and development, career goals, etc. Either the staff member or their supervisor can instigate such discussions. These informal talks will make the actual formal appraisal less stressful and uncertain, and more productive.

How should employees be rated?

Performance standards should not be unrealistically high, as the goal is not perfection but consistent striving for improved performance.

Performance appraisals provide an excellent opportunity to focus on an employee’s performance by highlighting examples of good work, and discussing areas that may require improvement. Well-executed performance appraisals can make employees feel valued, useful, and challenged in their jobs. If done properly, it can be a positive experience, and a useful tool for improving employee productivity and contribution, as well as developing professional skills.

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E. Termination

What justification is needed to terminate an employee?

To terminate for “just cause,” an employer should speak with a lawyer specializing in employment law. Demonstrating just cause can be difficult. Some steps that an employer may want to take in any case would include documenting non-performance over time. Ideally, an employer should be able to demonstrate that they have followed “progressive discipline” procedures.

For example, give an employee adequate warnings, from an oral warning (recorded in their personnel file) to a written notice stating the problem and proposed solution. It is important to have the employee sign any disciplinary documentation placed in their file, and include any employee comments in response to discipline. If performance remains unsatisfactory, follow up by either a second written notice or termination.

What kind of notice is required for termination?

If the employee’s contract is limited to the Employment Standards Act (ESA), generally the employer must provide a written notice of termination, termination pay or a combination (as long as the notice and termination pay together equal the length of notice the employee is entitled to). The period of statutory notice vary depending on the length of employment, from one week for staff employed between three to12 months, to eight weeks for staff employed eight years or more.

If the employee does not have a contract limiting notice or pay in lieu of notice to the ESA, the common law will apply. Often, this works out to one month of pay for every year worked up to a maximum of two years. In these cases, the courts will look at a variety of factors, including how senior the employee was, how long the employee worked for the employer, how old the employee is, what the employee’s chances of

future employment are, and whether the employee was induced in any way to accept the position.

When calculating notice or pay in lieu of notice, it is recommended an employer speak with a lawyer.

When are employees not entitled to a notice of termination or termination pay under the ESA?

Examples include: employees who are guilty of willful misconduct, disobedience, or willful neglect of duty that is not trivial and has not been condoned by the employer, employees on temporary layoff, employees who refuse an offer of reasonable alternative employment, and employees who have been employed less than three months.

Employers should contact a lawyer prior to making decisions regarding notice or termination pay.

What are the employer’s requirements during the statutory notice period?

During this period, an employer must:

• not reduce the employee’s wage rate or alter a term or condition of employment

• continue to make whatever contributions are required to maintain the employee’s benefits plans, and

• pay the employee the wages he or she is entitled to, which cannot be less than the employee’s regular wages for a regular work week.

Terminating an employee is never easy, but is sometimes necessary. The rules on your obligations and the employee’s rights can be complex. For information, check the Ministry of Labour at http://www.labour.gov.on.ca/english/es/pubs/guide/termination.php, or call the Employment Standards Information Centre at 1.800.531.5551. It is always advisable to obtain legal advice before terminating an employee. Here are some guidelines.

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Maintaining good human resource practices is a step in the right direction for ensuring that staff will be productive and the practice will grow steadily. Your aim should be for the staff to meet the practice’s goals and objectives through the consistent expected execution of their responsibilities. By developing job descriptions, monitoring staff performance, and providing frequent feedback, you are laying the groundwork for a successful practice.

F. Conclusion

The Guide and its contents (the “Guide”) provide general information on the subject matter set out in the Guide’s title. The Guide is not intended to provide specific advice as appropriate advice will vary in different circumstances. The Guide has been developed and is owned by the Ontario Medical Association (OMA). The Guide is protected by Canadian copyright law. The Guide shall not be reproduced, published, distributed, sold, posted, communicated, disseminated, broadcasted or otherwise made available without the prior written consent of the OMA.

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Appendix A: Assessing staffing needsThe following is a list of questions that will help serve as a reminder of the points you should address in the review of your staffing needs. For someone who does not have an established practice, this should be part of your start up plan. Those joining an established practice can use this to assist in the staffing demands that your added presence will entail. You should also include additional questions if your office or clinic has specific requirements.

Internal

1. Will there be a change in the number of physicians or number of hours the physicians are working in the office?

2. Do you expect the permanent or temporary departure of one or more of your employees?

3. Are any of the physicians planning to change their activities in the office in a way that may impact the staffing needs (e.g., introduction of new in-office procedures, shifting the profile of the practice, etc.)?

4. Is the volume of patients seen by one or more of the physicians expected to change significantly in the future?

5. Are there tasks or processes that you could delegate to an employee?

6. Are there problems in your office policies that are hindering the proper function of your office (e.g., holidays, sick leave, internal communications, etc.)?

7. Are things falling between the cracks because tasks or responsibilities are not properly assigned?

8. Are there deficiencies in the actual layout or amount of floor space that is hindering employees from accomplishing their work?

External

1. Have there been changes in the labour laws or rules that may impact the way you manage your employees?

2. Do you expect changes in revenues or methods of payment for your services that may affect the budget for your staff?

3. Is there new technology to be incorporated into your practice that will have to be mastered by your staff?

4. Are there new work trends that may be a benefit or a threat to the way your office functions? (e.g., job sharing)

5. Is the community or area where you work changing in a way that may impact your ability to find proficient employees (e.g., changes in unemployment, economic changes, and increase competition for employees)?

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Appendix B: Recruiting/Hiring process checklistThis list is not an exhaustive compilation of everything you need to do when recruiting and hiring staff, but it should make for a good start to keep track of your efforts and the tasks to be completed.

Pre-Interview Process Completed

Create new job description (update current job description if one exists) oDevelop qualifications and criteria needed for the position oDetermine salary range and compensation for the position oPost the job – e.g. internal postings, online, newspaper, employment agencies o

Interview Process: Completed

Develop standardized interview questions oMeet with all interviewers to determine the process of the interviews oScreen resumes against qualifications and criteria established oCreate a short list of qualified candidates oConduct phone interviews with short list candidates oSchedule interviews for qualified internal candidates (if any) oSchedule interviews for qualified external candidates oConduct interviews oGive candidates a copy of the job description during the interview Conduct interviews oUse a rating scale form to determine top candidates oDiscuss with interviewers which (if any) candidates will have a second interview oSchedule second interviews (if necessary) oReach consensus on the best candidate and check references o

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Post-Interview Process: Completed

Make an offer to the selected candidate and send letter confirming offer* oNotify interviewed candidates not selected via phone, email or letter oConfirm acceptance with selected candidate oEnsure all necessary documents and/or orientation are in place for start date oFinalize the hiring process oWelcome your new employee o

*The Offer package should include, but not limited to, a letter outlining start date, expected salary, reporting relationship, supervising relationship, job description, Confidentiality Agreement, and any other benefits or commitments that were negotiated with the candidate.

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Appendix C: Human resources legislation links• The Ontario Employment Standards Act (ESA), which sets minimum standards for conditions of employment in

most workplaces in Ontario: http://www.labour.gov.on.ca/english/es/

• The Ontario Human Rights Code, whose goal is to prevent discrimination and harassment and provide equal rights and opportunities in specific areas such as jobs, housing and services: http://www.ohrc.on.ca/en/resources/code

• The Ontario Occupational Health and Safety Act (OHSA), which protects workers’ health and safety on the job: http://www.labour.gov.on.ca/english/hs/. Under changes made in 2010, that includes protection from workplace violence and harassment: http://www.labour.gov.on.ca/english/hs/topics/workplaceviolence.php

• The Pay Equity Act, which protects the principle of equal pay for work of equal value: http://www.payequity.gov.on.ca/EN/Pages/default.aspx

• The Workers’ Compensation Act, which provides compensation and other benefits to workers and to their survivors and dependents: http://www.e-laws.gov.on.ca/html/repealedstatutes/english/elaws_rep_statutes_90w11_e.htm

• Accessibility for Ontarians with Disabilities Act (AODA), which strives to make Ontario accessible to all: http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_05a11_e.htm

• Employment Insurance information for employers: http://laws-lois.justice.gc.ca/eng/acts/e-5.6/

• Information and Privacy Commissioner of Ontario, which upholds and promotes open government and the protection of personal privacy in Ontario: http://www.ipc.on.ca/english/Home-Page

Additional resources:

• Service Ontario – Human Resources Management for Employers: https://www.jobsetc.gc.ca/eng/pieces1.jsp?category_id=2801

• Complying with the ESA: A Workbook for Employers: https://www.labour.gov.on.ca/english/es/pubs/fs_compliance.php

• Checklist of tasks for dealing with records of personal health information in compliance with the requirements under the Personal Health Information Protection Act, 2004 (PHIPA): http://www.ipc.on.ca/images/Resources/up-abandonedrec_chklst.pdf

• College of Physicians and Surgeons of Ontario: www.cpso.on.ca

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Appendix D: Job description templateJob Title: The formal title of the position

Reports to: The title of the position that the job incumbent reports to

Grade: The salary grade that the position falls within (if you use a grading system)

Job Summary

Provide a brief summary (1-2 sentences) of the scope, objective or role, and key responsibilities of the position. Give an overview of why the job exists and what the job is to accomplish. Highlight its reporting relationship and responsibilities.

Responsibilities and Duties

• List 3 – 5 major responsibilities and duties in descending order of importance. Importance is related to those responsibilities that most contribute to carrying out the purpose of the job.

• Begin each statement with an action verb and use the present tense of the verbs, e.g. “Greet patients to the office in a professional and friendly manner” or “Reconcile accounts payables/receivables, and produce financial statements on a regular and timely basis”.

Qualifications – Education and/or Work Experience

This section asks about knowledge and skill requirements of the job which are experienced-based. They are the abilities required to perform the daily tasks and job duties listed above, not necessarily those possessed by an incumbent.

• List minimum education/credential needed in order to be able to perform the job at a normal level of performance. (List what is required by this job NOT what the incumbent possesses). Be as specific as possible about names of certificates, degrees and specific job-related training programs, e.g. “Undergraduate degree in Health Care Administration”.

• List skills and knowledge requirements that are experienced-based, e.g. “Experience in policy development and implementation” or “Excellent verbal and written communication skills, including ability to effectively communicate with internal and external clients”.

• List minimum experience needed in order to be able to perform this job at a normal level of performance. e.g. “5 years’ experience required in the health care field, including demonstrated knowledge of OHIP billing”.

All qualifications must comply with provincial human rights legislation.

Working conditions

Identify the working conditions which relate to the essential functions of the position, such as working indoors/outdoors, working with exposures to hazards, etc. Include special considerations for the position, such as occasional travel, necessary overtime, shift work or evening work, e.g. “Work involves evenings and some weekends”.

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Physical Requirements

Identify the physical demands which relate to the essential functions of the position. A physically demanding job is one where the incumbent is required to stand for extended periods of time, lift heavy objects on a regular basis or do repetitive tasks with few breaks, e.g. “Must be able to lift and carry up to 50 lbs.”

Direct reports

Direct supervisory responsibility includes the authority to hire, transfer, suspend, promote, terminate, assign, reward or discipline subordinate employees or effectively recommend such actions. List by job title any positions to be supervised by the incumbent.

Approved by: Signature of the person with the authority to approve the job description

Date approved: Date when the job description was approved

Reviewed: Date when the job description was last reviewed

A job description should be reviewed annually and updated as often as necessary to ensure that it stays current and relevant.

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Appendix E: Interview questions templateBelow are some questions that can be helpful with starting a conversation in an interview.

1. How do you define teamwork?

2. What would you consider to be a great workplace?

3. What do you like the most and the least about your current job?

4. Describe your work style?

5. If I called your supervisor, what would he/she say about you?

6. Can you commit to work occasional overtime? (Ask this if the office hours may require the employee to work overtime or irregular hours.)

7. How do you handle pressure at work?

8. What would you do if you believe your supervisor is wrong about your performance?

9. What would you do if you believe your co-workers were doing something wrong?

10. What kind of support will you need to do your job well?

11. Why are you leaving your current job?

12. What are your strengths? What are your weaknesses? (Ask for examples.)

13. What are your short-range plans?

14. Why should we hire you?

15. What is your salary expectation?

16. Do you have any questions that you would like to ask me? (Always provide an opportunity for a candidate to ask a few questions.)

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Appendix F: Interview rating scale form templateInterview Rating Form

Candidate: _______________________________________________________

Position: _______________________________________________________

Date of Interview: _______________________________________________________

Interviewer(s): _______________________________________________________

Area of competence Rating

Administrative experience – duties outlined in the job description

Personal attributes – presence, analytical skills, etc.

Relationships – interpersonal skills, ability to meet/greet, communication, etc.

Financial experience – accounting, billing, etc.

Supervisory management – delegation, supervisory skills, etc.

Career progression – still growing/plateaued, long-term/short-term goals, etc.

Conflict of issues/other issues

Conduct interviews

Total Score

Rating scale:

5 – Outstanding; 4 – Above average; 3 – Average; 2 – Below average; 1 – Poor; 0 – Not applicable

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Appendix G: Code of conduct templateA Code of Conduct is a business performance tool that sets out the rules and standards for staff. Each medical office has to create a code that meets their specific requirements for their employees’ behaviours, as there are no guidelines for developing a code of conduct specifically for a medical setting. This is an example only, and would not be applicable to all medical offices.

_________________________________ Code of Conduct

(Practice Name)

Purpose:

To provide standards for employee conduct that promotes quality patient care and reflects the expectations of the public for medical practice employees who provide care to patients.

Policy:

All practice employees are expected to conduct themselves both on and off the job in accordance with the definitions and standards set forth in this policy. An employee who violates the expectations for conduct set forth in this policy will be subject to disciplinary action, which may include dismissal. Not every situation that may arise can be anticipated and included in policy. Employees are expected to understand the fundamental expectations governing conduct and apply them to situations that may arise.

Definitions:

Guiding Principles: The practice has established the following guiding principles as a fundamental basis to guide business and employee behaviour:

• Keep people safe

• Treat people with respect, trust, and dignity

• Consider all patient needs with sensitivity

• Support informed choice and decision making

• Advance the mission of the practice through teamwork

• Ensure public trust through personal and professional integrity

On-the-Job Conduct: The employee’s response to any assigned duty, responsibility, expectation, obligation or behaviour required of the employee by the employer or the position.

Off-the-Job Conduct: The employee’s off-duty behaviour, which maintains expected ethical and conduct standards and does not discredit or adversely impact the practice’s image or public trust.

Public Trust: The holding of health-care employment is a public trust, created by the confidence that the patients have in health-care employees. That trust requires adherence to integrity, responsible performance, and correctness in conduct both on and off the job.

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Responsibilities:

Employees are responsible for their conduct and behaviour both on and off the job.

Supervisors are responsible for ensuring employees understand the expectations for conduct outlined in this policy and appropriate follow up action is taken if expectations for conduct are breached.

Procedure:

The following is a partial list of guidelines for conduct. It is not intended to be exhaustive or to anticipate any situation that may arise. Employees are expected to rely on their training and knowledge of practice policy, and when possible should consult with their supervisor or co-workers to address questions about whether a behaviour is acceptable.

A. Expectations for Employee Conduct

1. Be cooperative with others. Demonstrate good teamwork principles. Recognize that our practice is only successful if we are successful as a team.

2. Demonstrate initiative. See things that need to be done, do not wait until you are told to do something.

3. Use practice guiding principles as a basis for decision-making.

4. Always be respectful of patients and their families. Respond to patients in a caring, empathetic manner no matter what their behaviour. Display a welcoming and hopeful attitude towards those we serve. Remember, patients are our customers, and while they may present challenges, they are never a burden.

5. Always adhere to principles of patient confidentiality. Only share patient information with those who have a “legal right to know.” Never discuss patients in public places at work or away from work.

6. Uphold and reinforce the rights of patients.

7. Maintain self-control and utilize appropriate conflict resolution strategies when confronted by people who are angry.

8. Refrain from sharing significant personal information about yourself, your family, or your co-workers with patients.

9. Maintain therapeutic boundaries with patients and former patients. Do not engage in any type of socialization or relationship that maybe outside of the professional role of care provider. If in doubt, seek advice from supervisors or treatment team members.

10. Inform supervisory personnel of any patient with whom you have had a relationship with outside the practice. Request a modification in your assignment if a personal relationship with a patient may compromise your ability to provide quality, objective care.

11. Provide care for patients using the techniques and procedures taught in orientation and in-service education programs.

12. Report to work on time and as scheduled. Only leave your work area when properly relieved and with your supervisor’s approval.

13. Promptly report safety hazards and take prompt action to prevent injury to others until the problem can be corrected.

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14. Follow the practice’s policy on tobacco use, and encourage others to do so as well.

15. Use telephones, radios, computer, and copier equipment in accordance with practice policy. Keep personal use of telephones to a minimum and do not let it interfere with practice business. Essential personal long distance calls must be collect, charged to a personal third-party number, charged to a personal credit card, or made using a calling card. Internet use must adhere to practice policy.

16. Always use proper telephone etiquette whenever answering the telephone or when calling others. Identify yourself and your work area, be courteous, offer assistance, write down messages and repeat names and numbers back to the caller to check for accuracy.

B. Unacceptable Conduct

1. Neglect or failure to properly carry out duties, responsibilities, or assignments.

2. Abuse, mistreatment or neglect of any patient.

3. Theft, willful damage, misappropriation or neglect of patient property or property of the practice.

4. Insubordination or refusal to follow verbal or written instructions of a supervisor.

5. Any conduct such as use of alcohol, or use or sale of drugs, either on or off the job that adversely impacts the employer’s operation (including absence from work) or brings discredit upon the employer’s mission or public trust.

6. Willful, intended or threatened harm to patients, family members, co-workers, or others.

7. Falsification of practice records (e.g., time sheets, patient records, travel expenses, omission of pertinent data, giving false testimony, etc.).

8. Behaviour intended to harass or threaten patients or co-workers.

9. Failure to report or disclose information concerning allegations of possible patient abuse, neglect, or other wrongdoing.

10. Improper disclosure of confidential information.

11. Wilful violation of law, contract, policy, or directives. Failure to carry out assignments or responsibilities.

12. Improper or illegal use of the practice’s telephone, radio, or computer network system. Improper use of the practice’s copy machines.

13. Unauthorized use of work time, equipment, or facilities for private business or personal use.

14. Sleeping on the job.

15. Failure to abide by the practice’s dress code or maintain personal hygiene in a manner acceptable to the practice environment.

16. Failure to appropriately respond in an emergency situation.

17. Unauthorized duplication or inappropriate use of keys. Loaning or providing keys to others without authorization.

18. Developing a relationship with a patient that violates expected patient-staff boundaries and therapeutic principles. Failing to report a personal relationship with a patient or former patient outside of the work setting.

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19. Performing special favours for patients that are outside the medical treatment process, without authorization from the patient’s treatment team.

20. Failure to treat patients, visitors, co-workers, and the public in a courteous, productive, respectful, and otherwise acceptable manner.

21. Failure to follow safe work procedures.

22. Failure to dispose of bio-hazardous or infectious waste in designated containers.

23. Failure to report defective equipment or unsafe conditions.

24. Reporting to work under the influence of illegal substance. Using, selling, possession of illegal substances during work hours or on the practice’s property.

25. Failure to perform essential job functions.

26. Off-the-job conduct that may discredit the practice’s image and the public trust.

27. Use of profane or vulgar language (as commonly considered) in a manner that others find offensive.

28. Conducting business on behalf of the practice without the permission of senior management.

C. Discipline

Discipline and corrective action procedures for violations of the employee conduct policy will be handled in accordance with practice policies and procedures. Discipline will be commensurate with the severity of the violation, particularly the impact upon patients. Serious infractions, whether occurring on-the-job or off the job may result in dismissal from employment.

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Appendix H: Policy and procedure manual content template

• Medical practice’s mission, vision and values

• Administration

` Personnel policies

• Hiring guidelines

• Job descriptions (list of job titles, roles and responsibilities)

• Termination guidelines

• Reporting guidelines

` Salary

• Payroll procedures

• Salary grades and scale

` Compensation (benefits, life insurance, etc.)

` Laws and regulations

• Office hours (include guidelines on breaks)

• Overtime policy

• Public holidays

• Vacation time, sick leave, bereavement time

• Accessibility for Ontarians with Disabilities Act

• Office Management

` Code of conduct (see Appendix VII)

` Staff meetings

` Conflict management

` Workplace harassment policy

` Social media policy (Internet, email, etc.)

` Use of equipment for personal use

` Training and development

` Health and safety procedures

• Emergency Procedures

` Emergency telephone numbers

` Basic staff preparedness

` Emergency in office (with and without a physician)

• Patient Management

` Telephone procedures (preferred greetings, customer service tips, etc.)

` Handling angry/violent patients

` Patient privacy and confidentiality (leaving messages for patients, etc.)

` Patient traffic flow procedures

` Patient scheduling (appointment booking, cancellation procedures, etc.)

` Medical records (filing, confidentiality, legal obligations, etc.)

• Billing

` How to submit claims to OHIP and WSIB

` How to reconcile Remittance Advice (RA) and Error Reports

` How to bill and collect payment of non-insured services

` Accounting procedures

• Clinical area procedures

• Laboratory services procedures

• Hospital privileges

• Office inventory and maintenance procedures

The contents of an Employee Policy and Procedure Manual will depend on your type of practice. The list of topics can include (and may not be limited to) the following.

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Appendix I: Performance appraisal template

Medical practice name & logo

Employee:

Job Title:

Review Date:

Performance Ratings:

1. Outstanding – performance consistently exceeds expectations.

2. Above Expectations – performance frequently exceeds expectations.

3. Meets Expectations – performance meets expectations.

4. Below Expectations – performance occasionally fail to meet expectations.

5. Needs Improvement – performance is unsatisfactory and fails to meet expectations.

Job Responsibilities :

Summarize the key responsibilities and duties that the employee performs as established in the job description (list 3-5 in order of importance).

Primary Job Responsibilities Comments on performance and/or areas for improvement

Performance rating

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Performance Competencies (skills and behaviours) - how the employee performs the job.

Competency Area Comments on performance and/or areas for improvement

Competency rating

Patient focus

Taking responsibility

Problem solving

Collaboration

Communication/Interpersonal

Growth and Development Plan – to be completed in cases where the employee’s rating is identified as “Needs Improvement”

Improvement Area(s) Identified Plan Timeline

Overall Assessment– summarizes the employee overall performance.

Employee’s Overall Comments Supervisor’s Overall Comments

Employee’s Overall Comments Supervisor’s Overall Comments

o I agree with the appraisal as written (no response provided).

o I agree with the appraisal as written (response provided).

o I do not agree with the appraisal as written (no response provided).

o I do not agree with the appraisal as written (response provided).

Employee Signature: _______________________________ Date: _____________________

Supervisor’s Signature: _____________________________ Date: _____________________

This document was prepared by OMA Practice Management & Education department.

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Please contact us for more information.Ontario Medical Association150 Bloor Street West, Suite 900 Toronto, ON M5S 3C1

1.800.268.7215

practicemanagement@oma.org

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